Individual
DEBORAH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
280 PINE FOREST DR, LAWRENCEVILLE, GA 30046-6032
(404) 593-8502
Mailing address
280 PINE FOREST DR, LAWRENCEVILLE, GA 30046
(404) 593-8502
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
001558
GA
Other
Enumeration date
11/17/2014
Last updated
11/17/2014
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